cardiac_Pre-class+medication+supplement+2024.docx

Chapter 26- Hypertension increases risk of myocardial infarction (MI), heart failure, cerebral infarction and hemorrhage and renal disease. +-----------------------+-----------------------+-----------------------+ | Angiotensin-convertin | Action | Nursing | | g...

Chapter 26- Hypertension increases risk of myocardial infarction (MI), heart failure, cerebral infarction and hemorrhage and renal disease. +-----------------------+-----------------------+-----------------------+ | Angiotensin-convertin | Action | Nursing | | g | | considerations | | enzyme inhibitors | | | | (ACE-I) | | | +=======================+=======================+=======================+ | \*Captopril (Capoten) | - Reduce | - Should be | | | proteinuria and | administered 1 | | \*Lisinopril | slow progression | hour before or 2 | | (Prinivil) | of renal | hours after meals | | | impairment in | | | Benazepril (Lotensin) | people with | - Monitor blood | | | diabetes; | pressure | | Enalapril (Vasotec) | however, they may | | | | cause proteinuria | - May cause acute | | Fosinopril (Monopril) | and renal damage | hypotension when | | | in people who do | treatment | | | not have | initiated | | | diabetes. | | | | | - Assess for cough- | | | - Block enzyme that | indicating | | | normally converts | possible allergy | | | angiotensin 1 to | and angioedema | | | angiotensin II | | | | and therefore | - Monitor potassium | | | decrease | for hyperkalemia | | | vasoconstriction | | | | (vasodilate) and | - Monitor renal | | | aldosterone | function for | | | production | elevating | | | (reduce retention | creatinine | | | of sodium and | | | | water). | | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | Angiotensin II | Action | Nursing | | receptor blockers | | considerations | +=======================+=======================+=======================+ | \*Losartan (Cozaar) | - Resemble effects | - Often ineffective | | | of ACE-I's; | with African | | Candesartan (Atacand) | however, less | American | | | likely to cause | population | | Irbesartan (Avapro) | hyperkalemia and | | | | occurrence of | - May take without | | | persistent cough | regard to meals | | | is rate. | | | | | - Monitor blood | | | - Increases renal | pressure, | | | flow and enhances | dizziness, muscle | | | excretion of | cramps, weakness, | | | chloride, | heartburn, | | | calcium, | diarrhea | | | magnesium, and | | | | phosphate | - Monitor renal and | | | | liver function | | | | and electrolytes | +-----------------------+-----------------------+-----------------------+ | Calcium Channel | Action | Nursing | | Blockers | | considerations | +-----------------------+-----------------------+-----------------------+ | \*Amlodipine | - Useful for | - First line of | | (Norvasc) | persons with | treatment for | | | hypertension that | African American | | \*Diltiazem | also have angina | people | | (Cardizem) | or other | | | | cardiovascular | | | Nifedipine | disorders | | | (Procardia) | | | | | - Current | | | Verapamil (Calan) | guidelines | | | | recommend CCBs be | | | | used alone or in | | | | combination with | | | | thiazide | | | | diuretics | | | | | | | | - *Amlodipine* | | | | dilates | | | | peripheral | | | | arteries and | | | | decrease | | | | peripheral | | | | vascular | | | | resistance by | | | | relaxing vascular | | | | smooth muscle but | | | | doesn't control | | | | rate; *Diltiazem* | | | | is used when rate | | | | and blood | | | | pressure need to | | | | be controlled. | | +-----------------------+-----------------------+-----------------------+ Chapter 34- Drugs used to treat fluid volume excess, thereby increasing urine formation and output are referred to as diuretics. Diuretics increase renal excretion of water, sodium and other electrolytes. They have important role in management of both edematous (heart failure, renal and hepatic disease) and non-edematous (hypertension, ophthalmic surgery) conditions. +-----------------------+-----------------------+-----------------------+ | Loop Diuretics | Action | Nursing | | | | considerations | +=======================+=======================+=======================+ | \*Furosemide (Lasix) | - Inhibit sodium | - Effective when | | | and chloride | Glomerular | | Bumetanide (Bumex) | reabsorption in | filtration rate | | | the ascending | (GFR) is low | | | limb of the loop | | | | of Henle | - Monitor fluid and | | | | electrolyte | | | - Potent- | imbalances | | | significant | (hyponatremia; | | | diuresis | hypokalemia) | | | | | | | | - Check allergies | | | | to sulfonamides | | | | | | | | - Adverse effects: | | | | O | +-----------------------+-----------------------+-----------------------+ | Thiazide Diuretics | Action | Nursing | | | | considerations | +-----------------------+-----------------------+-----------------------+ | \*Hydrochlorothiazide | - Decreases | - Used to treat | | | reabsorption of | mild to moderate | | | sodium, water, | hypertension and | | | chloride, and | edema | | | bicarbonate in | | | | the distal | - Note cross | | | convoluted tubule | sensitivity with | | | | sulfonamide | | | | agents | | | | | | | | - Adverse effects: | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | Potassium-sparing | Action | Nursing | | diuretics | | considerations | +=======================+=======================+=======================+ | \*Spironolactone | - Inhibits | - Contraindicated | | (Aldactone) | mineralocorticoid | in renal | | | receptors and | insufficiency | | | blocks the | because: | | | effects of | | | | aldosterone | - Many drug and | | | (which causes | herb | | | retention of | contraindications | | | sodium and water | | | | and loss of | - Increases the | | | potassium). | half life of | | | | digoxin- watch | | | | for dig toxicity | | | | | | | | - Potassium | | | | sparing, so may | | | | lead to | | | | hyperkalemia, | | | | hyponatremia, | | | | hypomagnesemia, | | | | hyperchloremic | | | | alkalosis | | | | | | | | - Patient teaching: | +-----------------------+-----------------------+-----------------------+ Chapter 28-Coronary Artery Disease is the result of damage to the intima, or inner layer of the coronary arteries, leading to a buildup of lipids and fibrous matter. A variety of irritants, including chemicals, drugs, or viruses may cause additional injury. +-----------------------+-----------------------+-----------------------+ | Nitrates | Action | Nursing | | | | considerations | +=======================+=======================+=======================+ | \*Nitroglycerin | - Potent | - For use in sudden | | | vasodilator that | onset angina as | | Indicated in the | relaxes smooth | well as | | management and | muscle in blood | management of | | prevention of acute | vessels. Angina | recurrent, | | chest pain caused by | chest pain is | chronic angina. | | myocardial ischemia | relieved by | | | | several | - Watch for | | | mechanisms | hemodynamic | | | | changes related | | | | to preload and | | | | vasodilation. | | | - Venous dilation: | | | | | - Common side | | | - Coronary artery | effects: | | | dilation: | headache- how is | | | | this treated? | | | - Arteriole | | | | dilation: | - Adverse effects: | | | | dizziness, | | | | bradycardia, | | | | syncope, | | | | hypotension, | | | | orthostatic | | | | hypotension | | | | | | | | - Contraindications | | | | : | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | Beta Adrenergic | Action | Nursing | | Blockers | | considerations | +=======================+=======================+=======================+ | *Cardiac Selective* | Beta blockers have | - *Cardio selective | | | become the | beta-adrenergic | | \*Atenolol (Tenormin) | cornerstone of drug | blockers*, such | | | therapy regimens for | as atenolol, | | \*Metoprolol | people with angina, | metoprolol, | | (Lopressor) | MI, HTN, HF, and | bisoprolol, offer | | | dysrhythmias. | potential | | \*Bisoprolol (Zebeta) | | advantage of not | | | - Inhibit | interfering with | | "BAM" | chronotropic, | bronchodilation | | | inotropic, and | or peripheral | | *Non-cardiac | vasoconstrictor | vasodilation in | | selective* | responses to | routine doses. | | | catecholamines | | | \*Inderal | epinephrine and | - At higher levels, | | (Propranolol) | norepinephrine, | cardioselective | | | by exerting | properties are | | | efforts on alpha, | diminished and | | | beta1 and beta 2 | can cause | | | adrenergic | shortness of | | | receptors. | breath and | | | | wheezing. | | |. | | | | | - Used to treat | | | | hypertension | | | | *accompanied with | | | | tachycardia* | | | | | | | | - Can mask early | | | | symptoms of | | | | hypoglycemia | | | | | | | | - Caution with | | | | bradycardia, | | | | heart failure, | | | | hypotension, and | | | | asthma | | | | | | | | - Used to treat | | | | angina and | | | | exercised induced | | | | tachycardia | | | | | | | | - Slows down | | | | glycogenolysis | | | | increased risk of | | | | hypoglycemia | | | | | | | | - Erectile | | | | dysfunction and | | | | wheezing are | | | | common side | | | | effects | +-----------------------+-----------------------+-----------------------+ Aspirin suppresses platelet aggregation without affecting important endothelial cell functions. A growing body of evidence supports the use of aspirin in both primary and secondary prevention of cardiovascular events. Page 573 +-----------------------+-----------------------+-----------------------+ | Salicylates | Action | Nursing | | | | considerations | | Thromboxane A~2~ | | | | Inhibitor | | | +=======================+=======================+=======================+ | Aspirin | - Suppress platelet | There is a growing | | | aggregation. | body of evidence that | | | | supports the use of | | | | aspirin in both | | | | primary and secondary | | | | prevention of CV | | | | events. | | | | | | | | Loading dose: | +-----------------------+-----------------------+-----------------------+ - Note! Aspirins analgesic, antipyretics, and anti-inflammatory benefits are not discussed her. Chapter 49- Morphine is useful for relieving pain, reducing anxiety, and decreasing preload, and remains a cornerstone in pain management in post MI with unacceptable levels of pain. The acronym ***MONA*** is used when someone comes into the hospital and has chest pain consistent with angina. The plan of care often includes morphine, oxygen, nitroglycerin and aspirin. Can you explain why this plan is often prescribed? Chapter 9- anticoagulant, antiplatelet and thrombolytic drugs are used in the prevention and management of thrombotic and thromboembolic disorders. A thrombus, or blood clot, can obstruct a blood vessel and block blood flow to tieesues beyond the clot either at the site of clot formation or to another part of the body. +-----------------------+-----------------------+-----------------------+ | Anticoagulant drugs | Action | Nursing | | | | considerations | +=======================+=======================+=======================+ | \*Heparin (Heparin) | - Inactivates | - Bleeding | | | clotting factors | precautions: | | -natural | IX, X, XI, XII | | | anti-coagulant | and inhibits the | - Hemodialysis does | | produced by mast | conversion of | not remove it | | cells | prothrombin to | | | | thrombin to | - Antidote: | | | prevent clot | | | | formation. | - Can be used | | | | prophylactically | | | | or | | | | therapeutically | | | | | | | | - Monitor for | | | | heparin induced | | | | thrombocytopenia | | | | (HIT) | | | | | | | | - Contraindicated | | | | in: | | | | | | | | - Normal aPTT: | | | | Therapeutic aPTT: | | | | Critical aPTT: | | | | | | | | - Normal PTT: | | | | Therapeutic PTT: | | | | Critical PTT: | +-----------------------+-----------------------+-----------------------+ | Low molecular weight | - | - | | heparin (LMWH) | | | | | | | | \*Dalteparin | | | | (Fragmin) | | | | | | | | \*Enoxaparin | | | | (Lovenox) | | | | | | | | \*Fondaparinux | | | | (Arixtra) | | | +-----------------------+-----------------------+-----------------------+ | Vitamin K antagonists | - Acts on the liver | - Antidote: | | | to prevent | | | \*Warfarin (Coumadin) | synthesis of | - Most useful in | | | vitamin K | long term | | | dependent | prevention or | | | clotting factors | management of | | | | venous | | | | thromboembolism, | | | | pulmonary | | | | embolism, and | | | | embolization | | | | associated with | | | | arterial | | | | fibrillation and | | | | prosthetic | | | | values. | | | | | | | | - Bleeding | | | | precautions: | | | | | | | | - Adverse effects: | | | | bleeding, nausea, | | | | vomiting, | | | | abdominal pain, | | | | alopecia, | | | | urticaria, | | | | dizziness, joint | | | | or muscle pain. | | | | | | | | - Contraindications | | | | : | | | | | | | | Black Box warning: | +-----------------------+-----------------------+-----------------------+ | Direct thrombin | - Inhibition of | DTIs have benefits | | inhibitors (DTIs) | both circulating | compared to heparin | | | and clot bound | and warfarin and are | | \*Dabigatran | thrombin | more predictable | | etexilate (Pradaxa) | | dose-response | | | | anticoagulant effect | | | | and antiplatelet | | | | effects and will not | | | | cause | | | | thrombocytopenia. | | | | | | | | - Antidote: | | | | Idarucizumab | | | | (Praxbind) | | | | | | | | - Uses: A fib, | | | | prevention and | | | | treatment of DVT | | | | | | | | - Therapeutic | | | | monitoring not | | | | required. | | | | | | | | - Adverse effects: | | | | | | | | Contraindications: | | | | renal insufficiency, | | | | can cause liver | | | | injury | | | | | | | | - At least as | | | | effective as | | | | vitamin K | | | | antagonists but | | | | are associated | | | | with less life | | | | threatening | | | | bleeding. | +-----------------------+-----------------------+-----------------------+ | Direct Factor Xa | - Inhibit | - Antidote: Andexxa | | Inhibitors | circulating and | | | | clot bound factor | - Uses: Afib, | | \*Rivaroxaban | Xa | prevention and | | (Xarelto) | | treatment of DVT | | | | | | \*Apixaban (Eliquis) | | - Adverse effects: | | | | | | | | - Contraindications | | | | : | | | | renal | | | | insufficiency, | | | | can cause liver | | | | injury | | | | | | | | - At least as | | | | effective as | | | | vitamin K | | | | antagonists but | | | | are associated | | | | with less life | | | | threatening | | | | bleeding. | +-----------------------+-----------------------+-----------------------+ Chapters 9- anti platelet drugs prevent one or more steps in the prothrombotic activity of platelets. +-----------------------+-----------------------+-----------------------+ | Antiplatelets | Action | Nursing | | | | considerations | +=======================+=======================+=======================+ | \*Aspirin (see above) | Prevents one or more | - No antidote-but | | | steps in the | may require | | | prothrombotic | platelet | | | activity of platelets | transfusion | | | | | | | | - Indicated in the | | | | preventions of | | | | MI, stroke and | | | | vascular death in | | | | patients with | | | | atherosclerosis | | | | and after | | | | coronary stents | | | | | | | | - Used in patients | | | | with afib that | | | | cannot take | | | | warfarin | | | | | | | | - Often clopidogrel | | | | is used in | | | | combination with | | | | ASA | | | | | | | | - Adverse effects: | +-----------------------+-----------------------+-----------------------+ | \*Clopidogrel | | | | (Plavix) | | | | | | | | \*Prasugrel (Effient) | | | | | | | | \*Ticagrelor | | | | (Brilinta) | | | +-----------------------+-----------------------+-----------------------+ Chapter 10- Elevated blood lipids are a major risk factor for atherosclerosis and cardiovascular disorders such as coronary artery disease and stroke. Dyslipidemia drugs are used to decrease blood lipids, prevent or delay the development of atherosclerotic plaque, promote the regression of existing atherosclerotic plaque and reduce morbidity and mortality from atherosclerotic cardiovascular disease. +-----------------------+-----------------------+-----------------------+ | HMG-CoA Reductase | Action | Nursing | | Inhibitors | | considerations | +=======================+=======================+=======================+ | \*Atorvastatin | - Decreases the | - Primary | | (Lipitor) | production of | prevention of | | | cholesterol | cardiovascular | | Simvastatin (Zocor) | | disease | | | | | | Lovastatin (Mevacore) | | - Beneficial for | | | | women with | | Fluvastatin (Lescol) | | cardiovascular | | | | disease. | | Pravastatin | | | | (Pravachol) | | - Caution | | | | concurrent use | | | | with grapefruit | | | | juice | | | | | | | | - Simvastatin, | | | | Lovastatin, | | | | Fluvastatin in | | | | the evening | | | | | | | | - Monitor for | | | | myopathies and | | | | muscle pain to | | | | rhabdomyolysis | | | | | | | | - Monitor kidney | | | | and liver | | | | function | | | | | | | | - Adverse effects: | +-----------------------+-----------------------+-----------------------+ Chapter 30- cardiac glycosides exert positive inotropic effects on the contractility of the heart muscle Digoxin (Lanoxin). Clinical trials support use of digoxin in heart failure patients with left ventricular dysfunction but is no longer considered first line. In patients with atrial fibrillation, digoxin slows down the rate of ventricular contraction. Nursing considerations include: